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New Customer Application: OTR

LandJet / 1090 Hall Ave. Jurupa Valley, CA 92509 / Tel: 1-626-333-9200

Name Of Business

First Name

Last Name

D & B Number

CCR Number

Tax I.D. Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

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Website

http://

Type Of Business

In Business Since

Legal form Under Which Business Operates:

If Division/Subsidiary, Name of Parent Company:

Billing Information (if different)

Billing Address

City

State

Zip

Phone

(###)

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Primary Contact

Name

First Name

Last Name

Position / Title

Phone

(###)

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Cell

(###)

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Fax Number

Accounts Payable Contact

Name

First Name

Last Name

Position / Title

Phone

(###)

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Cell

(###)

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Fax Number

FAQ:

Accessorial Charges The rates above are for (1) pick (1) Drop. There will be an additional charge of $150.00 for extra picks and drops. Max weight on a pallet is 1,500 LBS. Anything above this weight is considered a second pallet $400.00 additional charge for Night deliveries after 5:00 p.m. Night Deliveries not available in all Areas. All rates are based within a 25-mile radius of Los Angeles and all other Areas. Anything beyond the 25-miles radius will result in a price increase. Fuel surcharge will be added to the total. Lumper fee’s will be additional when applicable. Lumper fees paid onsite will be billed with a 10% Charge on top of fee. Waiting time will be charged at the rate of $100.00/hr. Billed every 15 minutes for LTL after 1hr, after the 2nd hr. for FTL. No pallet exchange, $25.00 per pallet and $50.00 per pallet for heat treated. ALL Extra CHARGES are automatically added unless you let us know to call for approval. Order Information All orders must be received no less than 72 hours in advance. Less than 72 hours will need to call for availability. Sailing Schedule Northern California: Monday – Friday (Orders Pick Up on Friday we deliver on Monday) Other days we deliver Next Day. Southern California: Monday – Friday (Orders Pick Up on Friday we deliver on Monday). We Offer Same Day Pick Up and Deliver with Extra Fee. Arizona: Monday – Friday (Orders Pick Up on Friday we Deliver on Monday). Saturday deliveries available for additional fee of $800.00 Texas: Product Needs to be Pick Up Thursday and Friday for Deliver Monday or Tuesday. WA: Product Needs to be Pick Up Friday for Deliver Tuesday to OR and WA on Wednesday.

I have read the following Accessorial Charges / Order Information / Sailing Schedule

Legal:

Net 30 based upon approval. Disputes: Must be submitted within 15 days from invoice date. All disputes must be submitted to your company contact. Collections: Any invoice balances will be sent to collections 60 days after invoice date. If the balance is not paid, or goes into default, your account will be sent to a Third-Party Collection Agency. You will be responsible for paying all Collection Fees assessed by the Third-Party Collection Agency. In the event of non-payment, I authorize and agree to pay for all fees assessed as a result of my account being delinquent or in default, including but not limited to court costs, costs of collection, collection agency fees up to 1/3rd or 33% of my delinquent balance, recovery costs and/or attorneys' fees as allowed by law.

I have read the following and am authorized to submit this form on behalf of the business stated above

Form Authorized Signature By:

First Name

Last Name

Date

YYYY

Credit Reference Application

LandJet / 1090 Hall Ave. Jurupa Valley, CA 92509 / Tel: 1-626-333-9200

Name Of Business

First Name

Last Name

D & B Number

CCR Number

Tax I.D. Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Website

http://

Type Of Business

In Business Since

Legal form Under Which Business Operates:

If Division/Subsidiary, Name of Parent Company:

Name of Principal Responsible for Business Transactions:

Title

Company Total Assets Income

Company Total Liabilities

Annual Net

Amount of Credit Requested:

Is your Company subject to any litigation?

If so, Describe:

Have you or your officers or affiliates ever filed a petition in bankruptcy?

If so, Describe:

Form Authorized Signature By:

First Name

Last Name

Date

YYYY

Trade References

Company Name

Contact Name

First Name

Last Name

Phone

(###)

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####

Address

Account Number

Account Open Since?

YYYY

Current Balance

Trade Reference 2

Company Name

Contact Name

First Name

Last Name

Phone

(###)

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####

Address

Account Number

Account Open Since?

YYYY

Current Balance

Trade Reference 3

Company Name

Contact Name

First Name

Last Name

Phone

(###)

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####

Address

Account Number

Account Open Since

YYYY

Current Balance

Checkbox

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.